Impact of Insurance Coverage on Access to Eating Disorder Treatment

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The Wharton School
The Wharton School::Wharton Undergraduate Research::Wharton Research Scholars
Degree type
Discipline
Adult and Continuing Education
Health and Medical Administration
Economics
Public Affairs, Public Policy and Public Administration
Mental and Social Health
Subject
Insurance Coverage
Eating Disorder
Access to Care
Insurance
Health Care
Mental Health
Barriers to Access
HealthCare Policy
Policy
Barriers to Access
Quality of Care
Public Health
Access to Care
Healthcare Policy
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Copyright date
2024
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Author
Sadioglu, Yael
Contributor
Candon, Molly
Abstract

The rising incidence and severity of eating disorders, along with demonstrated gaps in access, requires a better understanding of eating disorder treatment, particularly the insurance coverage landscape. In order to address this gap, I conduct a two-part analysis by identifying the insurance-related barriers to access and designing informed policies targeting those barriers. Using a framework developed by Eisenberg and Power (2000), I develop a conceptual model of voltage drops, defined as challenges that patients encounter that reduce the likelihood of receiving high-quality care for their eating disorders. I then conduct semi-structured interviews with 11 field experts from treatment centers, advocacy organizations, and legal backgrounds to gather their insight on barriers to accessing eating disorder treatment and suggestions to remove those barriers. I use rapid qualitative methods to identify key themes across interviews. Key barriers include public insurers’ inadequate coverage of ED services, private insurers’ narrow networks, restrictive eligibility criteria such as BMI cutoffs, and frequent utilization reviews with length of stay limitations. The main suggestions include expanding Medicare and Medicaid coverage, increasing standardization and transparency for private plans, and ensuring parity between eating disorders and other mental and physical health conditions. Finally, I translate the qualitative findings into actionable and comprehensive policy initiatives that target individual voltage drops. These include 1) policies targeting data collection via national organizations, such as CDC and NIH, 2) policies enhancing coverage for both public and private insurers through congressional agencies and state-level mandates, and lastly, 3) policies introducing accountability through network adequacy standards with secret shopper studies, and grassroots efforts, such as report cards and insurer rating platforms. Overall, this paper underscores the need to transform public and private insurance coverage for eating disorders and provides profound and targeted policy initiatives to do so.

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2024-05-01
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